Provider Demographics
NPI:1962450783
Name:GLICK, DEBORAH ZIPIN (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ZIPIN
Last Name:GLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN CREDENTIALING DEPT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-432-8200
Mailing Address - Fax:813-976-7823
Practice Address - Street 1:9776 BONITA BEACH RD SE STE 201A
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4775
Practice Address - Country:US
Practice Address - Phone:239-947-3092
Practice Address - Fax:239-947-5298
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87155207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021741500Medicaid
FLU0888ZMedicare UPIN